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Plexopathy - Wikipedia

From Wikipedia, the free encyclopedia

Plexopathy is a disorder of the network of nerves in the brachial or lumbosacral plexus. Symptoms include pain, muscle weakness, and sensory deficits (numbness).^[1]

Types

There are two main types of plexopathy, based on the location of the symptoms: brachial plexopathy (affecting the arm) and lumbosacral plexopathy (affecting the leg).

Cause

Brachial plexopathy is often caused from local trauma to the brachial plexus, as can happen from a dislocated shoulder. The disorder can also be secondary to compression or stretching of the brachial plexus (for example, during a baby's transit through the birth canal, in which case it may be referred to as Erb's Palsy or Klumpke's palsy).^[2] Non-traumatic causes of brachial plexopathy include diabetes, malignancy, and infection.^[1] Brachial plexopathy can also be idiopathic with an unknown cause, in which case it is known as Parsonage-Turner Syndrome.^[3] Both brachial and lumbosacral plexopathy can also occur as a consequence of radiation therapy,^[4] sometimes after 30 or more years have passed, in conditions known as Radiation-induced Brachial Plexopathy (RIBP)^[5] and Radiation-induced Lumbosacral Plexopathy (RILP).^[6]

Diagnosis

The first steps in the evaluation and management of plexopathy involve a medical provider obtaining a medical history and conducting a physical examination. Diagnosis of plexopathy relies on proper identification of a pattern in motor and sensory function deficits in the upper or lower extremities.^[1]

To rule out confounding conditions such as radiculopathy or myelopathy, an MRI of the cervical or lumbar spine is often obtained. If plexopathy is suspected after imaging, an EMG performed by a neurologist or physiatrist can help confirm a plexopathy, and clarify the localization within the brachial or lumbosacral plexus. Following electrodiagnostic testing, further imaging may be obtained of relevant soft tissue structures with either ultrasound or MRI. Some blood tests may help identify the cause of the plexopathy, including screening for diabetes, and obtaining a complete blood count (CBC) and a comprehensive metabolic panel (CMP).^[1]

Treatment

Management of brachial or lumbosacral plexopathy depends on the underlying cause. No matter the cause of plexopathy, physical therapy and/or occupational therapy may promote recovery of strength and improve limb function. In the case of a mass lesion causing compression of the brachial or lumbosacral plexus, surgical decompression may be warranted. In an idiopathic brachial plexopathy, no specific treatment is usually indicated, although there is limited evidence that steroids may hasten recovery.^[7] ^[8] If a brachial or lumbosacral plexopathy is determined to be caused by diabetes, management includes controlling the patient's blood sugar.^[9] For radiation-induced plexopathies, treatment options are often limited to pain/symptom management and provision of assistive devices.

References

^ ^a ^b ^c ^d Allan B. Wolfson, ed. (2005). Harwood-Nuss' Clinical Practice of Emergency Medicine (4th ed.). Lippincott Williams & Wilkins. pp. 614–615. ISBN 0-7817-5125-X.
^ "National Institute of Neurological Disorders and Stroke, page on Erb's and Klumpke's Palsies". Retrieved 2021-02-01.
^ "National Organization for Rare Disorders, page on Parsonage Turner Syndrome". rarediseases.org. Retrieved 2021-02-01.
^ "Radiation plexopathy - Introduction". www.medmerits.com. Retrieved 2016-03-03.
^ Stephenson, Ryan O (2024-01-31). "Radiation-Induced Brachial Plexopathy: Practice Essentials, Pathophysiology, Epidemiology". Medscape Reference. Retrieved 2024-08-08.
^ Yadav, Rajesh R (2023-09-05). "Radiation-Induced Lumbosacral Plexopathy: Practice Essentials, Pathophysiology, Epidemiology". Medscape Reference. Retrieved 2024-08-08.
^ "Brachial Plexopathy". Health Guide. The New York Times. 2009-12-09. Retrieved 10 December 2009.
^ Feinberg, J. H.; Radecki, J. (2010). "Parsonage-Turner Syndrome". HSS Journal. 6 (2): 199–205. doi:10.1007/s11420-010-9176-x. PMC 2926354. PMID 21886536.
^ "Lumbosacral Plexopathies: Diagnosis and rehabilitation". BNET. CBS Interactive Inc. 1999. Retrieved 10 December 2009.

This article incorporates public domain material from Dictionary of Cancer Terms. U.S. National Cancer Institute.

Diseases relating to the peripheral nervous system

Mononeuropathy

Arm

median nerve	Carpal tunnel syndrome Ape hand deformity
ulnar nerve	Ulnar nerve entrapment Froment's sign Ulnar tunnel syndrome Ulnar claw
radial nerve	Radial neuropathy Wrist drop Cheiralgia paresthetica
long thoracic nerve	Winged scapula Backpack palsy

Leg

lateral cutaneous nerve of thigh	Meralgia paraesthetica
tibial nerve	Tarsal tunnel syndrome
plantar nerve	Morton's neuroma
superior gluteal nerve	Trendelenburg's sign
sciatic nerve	Piriformis syndrome

Cranial nerves

See Template:Cranial nerve disease

Polyneuropathy and Polyradiculoneuropathy

HMSN	Charcot–Marie–Tooth disease Dejerine–Sottas disease Refsum's disease Hereditary spastic paraplegia Hereditary neuropathy with liability to pressure palsy Familial amyloid neuropathy
Autoimmune and demyelinating disease	Guillain–Barré syndrome Chronic inflammatory demyelinating polyneuropathy
Radiculopathy and plexopathy	Brachial plexus injury Pectoralis minor syndrome Thoracic outlet syndrome Phantom limb
Other	Alcoholic polyneuropathy

Other

General	Complex regional pain syndrome Mononeuritis multiplex Nerve compression syndrome Neuralgia Peripheral neuropathy

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Peripheral nervous system disorders

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References